Changes to Relocation and Referral Processes under MDS 3.0

The Centers for Medicare & Medicaid Services (CMS) recently revised the Minimum Data Set (MDS) 2.0; MDS 3.0 became effective Oct. 1, 2010. MDS 3.0 is a very different document both in substance and in philosophy. It approaches the nursing facility resident assessment from a more person-centered planning perspective in which residents are required to take a more active role in determining their individual service plan.

One of the major changes to MDS 3.0 is Section Q, or the "relocation/referral" section. The original Section Q was minimalistic and dependent on others to respond to the question. The MDS 3.0 Section Q is more robust and actively engages residents to determine their goals in pursuing going back to a community residence or remaining in a nursing facility setting.

The "new Q" asks s resident "Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community? If the resident answers "yes" a referral will be made to a third-party, independent community organization (local contact agency) to provide them information and potential assistance in relocating.

Nursing facilities are required to make the referral to the local contact agency and to ensure that there was a follow-up response. All people in Medicaid-certified nursing facilities, regardless of their payment source, must respond to Section Q and have a referral made on their behalf if they respond affirmatively to Section Q: Q0500B.

Texas already has an established, comprehensive statewide network of local contract agencies — or relocation contractors — that provides outreach, education, facilitation and case management for people who have expressed a desire to relocate. This coverage is available for people who are eligible for Medicaid. Please see listing below on which relocation contractor covers your facility.

Texas is a national leader with nursing facility relocation through its Money Follows the Person program. The new MDS 3.0 Section Q supports the U.S. Supreme Court's Olmstead decision (June 1999) and Texas' own Promoting Independence Initiative and Promoting Independence Plan. An individual's stated goal to relocate back to the community is one of choice and no one is required nor forced into this decision. For those who want to relocate, the state, the nursing facility, the local contact agency, the managed care organization (if appropriate) and the home health agency must work collaboratively to make the choice viable.

Additional information will be forthcoming in regarding how to help make the culture change among the nursing facility staff to support the new MDS 3.0 Section Q.